Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 01686 | Date 19/02/2019 |
| Token No | SM/18-19/2504 19/02/2019 | Serial | 005 |
| Patient Name | Mrs. MAMATA BARIK | Contact No | 8584948804 |
| Address | 44/1/C DR. N.L BHATTACHARYA ST | Age | 37 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||